高能量伤致非相邻多节段胸腰椎骨折诊断和手术治疗策略

Diagnosis and surgical treatment strategies of multilevel noncontiguous thoracolumbar fracture caused by high-energy injuries

目的探讨高能量损伤所致非相邻多节段胸腰椎骨折的特点、诊断及手术治疗方式。方法回顾性分析我院1995年1月至2009年1月手术治疗的高能量损伤所致非相邻多节段胸腰椎骨折患者37例,其中男28例,女9例,年龄19～55岁,平均34.5岁。总结影像学特点及手术前后美国脊髓损伤协会(ASIA)分级评分变化。结果 37例高能量损伤所致非相邻多节段胸腰椎骨折的主要骨折部位、骨折类型,以爆裂骨折和骨折脱位为主。脊髓不完全性损伤患者(B、C级)术后ASIA分级评分提高1～2级,而脊髓完全性损伤患者(A级)术后无改善。结论高能量损伤所致非相邻多节段胸腰椎骨折具有损伤暴力大、致伤机制复杂、脊髓损伤严重、伴发损伤多等特点。手术治疗应根据主要骨折部位及分型,选择固定融合节段。

Objective To discuss the clinical features of multilevel noncontiguous thoracolumbar fracture caused by high-energy injuries,and diagnosis and surgical treatment strategies.Methods Thirty-seven patients of multilevel noncontiguous thoracolumbar fracture treated by surgery from January 1995 to January 2009 in our hospital were retrospectively analysised. There were 28 males and 9 females,aged 19 to 55 years with the average of 34.5 years.We summarized the image features and follow-up improvements according to the American Spinal Injury Association（ASIA） classification.Results The fracture types of 37 cases of multilevel noncontiguous thoracolumbar fracture caused by high-energy injuries,were mainly burst fracture and fracture dislocation.After surgery,the ASIA classification of the incomplete spinal cord injury cases（class B or C） were improved 1-2 levels,whereas remained unchanged in the complete spinal cord injury cases（class A）.Conclusions The multilevel noncontiguous thoracolumbar fracture caused by high-energy injuries have a serious complex injury mechanisms,severe spinal cord injuries and many accompanied injuries.The segments of fusion and fixation should be carefully chose based on the positions and types of fractures in the surgical treatments.